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Objective:To study the safety and short-term clinical effect of no-touch technique for harvesting great saphenous vein in off-pump coronary artery bypass grafting(OPCABG).Methods:The clinical data of 117 patients in the single medical group who underwent OPCABG from December 2018 to April 2020 were analyzed retrospectively, including 55 patients in the no touch group (NTSV group) and 62 patients in the traditional open access group (traditional SV group). To evaluate the feasibility, safety and short-term clinical effect of using no-touch technique to harvest great saphenous vein for OPCABG. The no-touch technique was mainly based on the invention of Dr. Souza’s team in Sweden. For the treatment of isolated great saphenous veins, some improvements were made according to the clinical experience of the application of sequential bridging and radial artery in our center.Results:There were no significant differences between the two groups in hypertension, diabetes, hyperlipidemia, history of myocardial infarction, ventricular aneurysm formation, left ventricular systolic function reduction, history of cerebral infarction, chronic obstructive pulmonary disease and other complications ( P>0.05). The NTSV group had higher male proportion (96.4% vs. 61.3%) and lower mean age (53.49 years old vs. 63.76 years old), and the difference were statistically significant ( P<0.01). The patients in the two groups successfully completed the operation without cardiopulmonary bypass, and the proximal anastomosis was the first. There were no statistical significances in the average number of bypass, time to acquire great saphenous vein, operation time, 24 h postoperative thoracic drainage, blood bank transfusion, secondary thoracotomy and hemostasis, perioperative myocardial infarction, hospital death, ICU stay time, postoperative hospital stay time, and poor healing of lower limb incision of the two groups. One year after the operation, 36 patients were followed up, including 15 patients in NTSV group, and 21 patients in traditional SV group. There was no recurrence of angina pectoris, no out of hospital death and other major adverse cardiovascular events. Among them, 26 patients completed CTA reexamination of coronary artery, including 12 patients in NTSV group and 14 patients in traditional SV group, the patency rate of vein bridge was 96.4% vs. 87.2%. There was no reduction of left ventricular ejection fraction and no revascularization. Conclusion:The method of using no-touch technique to harvest great saphenous vein is safe and feasible. It does not increase the operation time and the incidence of poor healing of lower limb incision. The short-term effect of applying no-touch technique for harvesting great saphenous vein to OPCABG is better than the traditional open way.
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Objective To analyze the independent risk factors and complications for perioperative hyperbilirubinemia in Stanford type A aortic dissection undergoing operation and investigate the management strategy of perioperative hyperbilirubi-nemia. Methods Between January 2013 and January 2018 from the department of great vessel surgery of heart centre of,290 cases of patients with Stanford type A aortic dissection undergoing operation were collected consecutively,male 210 cases,fe-male 80 cases. The related data and perioperative peak hyperbilirubinemia were recorded. According to the perioperative peak hyperbilirubinemia,patients were divided into 2 groups:≥51. 3 μmol/ L group and < 51. 3 μmol/ L group. Univariate and lo-gistic regression analysis were used to identify the independent risk factors. The perioperative complications were also recorded. Results Preoperative total bilirubin ≥ 17. 1 μmol/ L(OR = 2. 105,95％ CI: 1. 153 - 3. 125,P = 0. 016),cardiopulmonary bypass time > 3. 5 h(OR = 1. 103,95％ CI: 1. 316 - 6. 151,P = 0. 031),a large number of hemolysis(OR = 1. 503,95％CI: 1. 506 - 6. 651,P = 0. 029),the input amount of 24 h allogeneic red blood cell > 2000 ml(OR = 1. 381,95％ CI:0. 956 - 2. 552,P = 0. 036)were the independent risk factors for perioperative hyperbilirubinemia. The incidence rate of post-operative acute hepatic failure(2. 5％ vs. 0,P = 0. 021)and artificial liver therapy(2. 5％ vs. 0,P = 0. 021)in≥51. 3μmol/ L group were significantly increased. The incidence rate of postoperative acute lung injury(37. 5％ vs. 25. 2％,P =0. 039)and acute kidney injury(38. 7％ vs. 19. 5％,P = 0. 035)in 51. 3 μmol/ L group were also significantly increased. The duration of mechanical ventilation[(4. 1 ± 1. 6)days vs. (2. 8 ± 1. 3)days,P < 0. 05]and ICU stay time[(5. 1 ± 2. 3)days vs. (3. 9 ± 1. 8)days,P = 0. 035]and hospitalization time[( 19. 3 ± 3. 1)days vs. ( 17. 3 ± 2. 5)days,P = 0. 035]were sig-nificantly prolonged. Temporary nerve dysfunction(52. 5％ vs. 32. 6％,P = 0. 002)and in-hospital mortality( 17. 5％ vs. 8. 1％,P = 0. 037)were significantly increased. Conclusion Preoperative total bilirubin ≥ 17. 1 μmol/ L,cardiopulmonary bypass time > 3. 5 h,a large number of hemolysis,the input amount of 24 h allogeneic red blood cell > 2000 ml were the in-dependent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection. The perioperative complications in≥51. 3 μmol/ L group were significantly increased. Therefore,more attention should be paid to the independent risk factors for perioperative hyperbilirubinemia in Stanford type A aortic dissection,hyperbilirubinemia and its clearance should be moni-tored more actively and dynamically,the cause should be found more precisely,the treatment be more comprehensive to achieve to control the level of bilirubinemia and improve the prognosis.
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To explore the relationship of the perioperative B-type natriuretic peptide [BNP] level with heart function among patients undergoing on-pump coronary artery bypass graft surgery on a beating heart. Total 90 patients expected to undergo coronary artery bypass graft surgery were selected and their left ventricular ejection fraction [LVEF] were examined before operation. Patients with LVEF greater than or equal to 50% were selected as the A group [n=46], and those less than 50% formed the B group [n=44]. BNP levels of the patients were examined and its relationship with cardiac function was analyzed. BNP levels of group A was lower than that in group B pre-and post-operatively [until 7 days after the surgery], the difference is statistically significant [p<0.05]. Pearson analysis showed that the BNP level was negatively correlated with the LVEF [r = 0.767, p< 0.05]. The area under the Roc curve is 0.865. BNP level was negatively correlated with the LVEF. Perioperative BNP level can be used as the prediction for heart function of patients with on-pump coronary artery bypass graft surgery on a beating heart
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Humans , Male , Female , Perioperative Care , Heart Function Tests , Coronary Artery BypassABSTRACT
Objective To compare the mid- and long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. Methods Two hundred seventy-seven patients underwent TV repair at our division (Sep. 2001 to Sep. 2008) ,of which 203 had, predominantly, a De Vega or Kay procedure (non-ring group) and 74had an annuloplasty with an artificial ring (ring group). TV pathology mainly was functional (secondary) and several with rheumatic leaflets involvement. Concomitant procedures consisted of mitral valve surgery in all patients,aortic valve surgery in 81 ,and coronary bypass in 19. Clinical and echocardiographic data followed for 1.5 to 3.5years were obtained. Results Postoperationally,the mid-term(1.5 years) follow-up was 100% completed and the long-term follow-up for 3. 5 years was 89. 9%. The recurrence of TV regurgitation (TR) of moderate and lower degree was not significantly different(χ2 = 1.3128, P= 0.26) in the 1.5 years follow-up between the two group,whereas the recurrence of TR of moderate to severity degree was significantly less in the ring group (χ2 =5. 8159,P =0.023).In the long term follow up,the TR in the ring group (25%) was significantly lower than that of 15% in the non-ring group (χ2 = 4. 9328, P = 0.036) . There are higher proportion of patients developing to moderate TR in the non ring group(34%) than in the ring group (10%) (χ2 =7. 9120,P =0.005). The TR developed fast in the ring group,increasing from 18% at 1.5 years follow up to 10% at 3.5 years follow up (χ2 = 2. 1327, P = 0.016),whereas it was relatively stable in the non-ring group,with 7% at 1.5 year follow up and 10% at 3.5 year follow up. Conclusions Placement of an annuloplasty ring in patients undergoing TV repair could remarkably improved the mid and long terum outcome. In clinic practice, we should be more positive to the functional TR and prefer to the procedure with annuloplasty ring.
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Objective To summarize the clinical experiences of total cavopulmonary connection (TCPC), investigate the applications and short and mid term effects. Methods From 1999 to 2007,31 patients with complex congenital heart disease underwent TCPC. All patients were divided into child group(≤16 years old ,n =21 ) and a-dult group( n = 10 ), including 15 cases of functional univentricle, 8 cases of complete atrioventricular septal defect with double outlet of right ventricle, 3 cases of transposition with double outlet right ventricle, 3 cases of tricuspid atresia, 1 case of double outlet of right ventricle with hypoplastic left heart. 1 case of corrected transposition of the great arteries with TOF. Among them, 1 patient had cortriatriatum, 10 patients had left superior vena cave, moderate or severe mitral valve insufficiency occurred in 1, moderate atrioventricular valve insufficiency occurred in 3.28 pa-tients underwent TCPC with cardiopulmonary bypass ( CPB ) and 3 patients without CPB ;Of them, 21 patients were treated with extracardiac conduit and 10 cases with intratrial lateral tunnel. Results There was no early death,post-operative death or large quantities of pleural effusion in child group;but two deaths and three patients with large quantities of pleural effusion in adult group. One case caught up in inferior venous stasis and was cured. Follow- up was carded out from 6 months to 6 years. 26 patients were in NYHA class Ⅰ ,2 patients in NYHA class Ⅱ and only one patient in NYHA class Ⅲ. Conclusions TCPC is effectively used for complex congenital heart disease which can not be corrected in anatomy;serious postoperative complications often occur in adults. Atrioventricular valve in-sufficiency decisively affects the short and midterm effects, even the long-term effects.
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Objective To study the brain protection of sequential double-sided antegrade cerebral perfusion to central nervous system in arotie arch surgery. Methods 24 patients received aortic arch replacement under deep hyperthermic circulatory arrest (DHCA) ,with fight-sided, and following double-sided, and left-sided,if necessary, antagrade cerebral perfnsion through right axillary arterial cannula or right femoral arterial eannula homeochronously. Post-operation recovery and the central nervous complications (CNC) were recorded and analyzed. Results 2 cases died, one of whom died of refractory low cardiac output syndrome and the other died of late massive gastrointestinal tract hemorrhage. No patient suffered severe CNC. Conclusion Sequential double-sided antegrade cerebral perfusion combined with DHCA can provide good brain protection in arotic arch replacement.